Roadster Gaskets - Mail order form

Roadster Gaskets 30 McDonald Road Wilmington, MA. 01887 (978) 658-9798

• Home • Technical Data • XPAG-XPEG • BMC-A • BMC-B • Spitfire • TR234 • TR6 • Order Form •

Mail Order Form

Date:-

Phone #(Days):-

customer Name:-

Phone #(Nights):-

Ship to Address:-

Catalog #                             Quantity

  MGA/MGB-VC-PRC

  MGT-VC

MGT-PRC

MGT-Combo
     (MGT-Combo Shipping - MA $8, USA & Canada $7, Worldwide $15)

BMCA-PRC

                   Unit Price                    Total

                     $24.95

                     $24.95

                   $24.95

                     $44.90

                    $9.95

BMCA-VC

$24.95

BMCA-Combo

$29.95

Spitfire

$24.95

TR234

$27.95

TR6

$29.95

Shipping & Handling:

	Single item	Combination
Massachusetts	US $7.00	US $7.00
US & Canada	US $7.00	US $7.00
Worldwide	US $12.00	US $12.00

Sub-Total	___________
MA Tax 5% (MA residents only)	___________
Freight (see shipping table on left)	_______________
Grand Total	___________

Make checks payable to Roadster Gaskets

     Mail to: - Roadster Gaskets
                  30 McDonald Road
                  Wilmington, MA 01887

geovisit();<script language="JavaScript" src="http://us.js2.yimg.com/us.js.yimg.com/lib/smb/js/hosting/cp/js_source/whv2_001.js"></script><script language="javascript">geovisit();</script><noscript><img src="http://visit.webhosting.yahoo.com/visit.gif?us1268225264" alt="setstats" border="0" width="1" height="1">